How often do you notice people using words like ‘depressed’, ‘sad’ and ‘low’ to describe how they are feeling? Many of us tend to use these terms interchangeably. However, there is a difference between being sad and being depressed.
Sometimes, a difficult or challenging event such as having a fight with a friend, going through a break-up, or having a bad day at work can make one feel sad. This feeling usually passes with time or a change in circumstances.
In some cases, however, these negative emotions persist over time. They might even become more intense. When this happens, one might find it hard to recover from periods of sadness or low mood. This can also affect one’s ability to go about day-to-day life.
When feelings of sadness or low mood persist for 2 or more weeks, they could indicate an episode of depression.
These are three core symptoms of depression.
When someone is feeling depressed, they experience intense feelings of sadness. These feelings often occur without a cause and are difficult to overcome. When you are sad, you’re likely to be aware of the reason for your sadness. In contrast, in case of depression, the sadness or low mood gets generalised towards all things in life. It becomes increasingly difficult to feel happy, and feelings of sadness and guilt take over completely.
When someone is experiencing depression, they lose interest in activities that they enjoyed before, like going for a run or reading books. They may not feel motivated to do things and might not look forward to activities they previously liked. Even if they engage in such activities, they may not experience pleasure or have fun. This, in turn, worsens their mood.
Someone who is depressed may complain of fatigue, sluggishness and feelings of heaviness even without engaging in any activity. The tiredness is overwhelming and looms over everything they do. As a result, they might find even the simplest of activities exhausting and might therefore avoid engaging in activities altogether.
Usually, people who are experiencing depression display at least one of the above signs along with other associated symptoms. These associated symptoms may be:
Some individuals struggling with depression experience an increase in appetite and may end up gaining weight. Others may not feel hungry at all. Sleep difficulties are commonly reported as well - in some cases, depression can lead to insomnia and poor quality sleep; other times, people may sleep for long hours, but still wake up feeling exhausted.
A lot of the distress experienced in depression stems from a set of negative and pessimistic beliefs. These negative thoughts might revolve around oneself, the world, and/or the future. As a result of this, feelings of hopelessness, helplessness, worthlessness, and guilt are common. Many times, people with depression can get stuck in a loop of negative thoughts and might find it hard to think in a positive or even balanced manner.
A person dealing with depression may be either be too fatigued or too preoccupied with their thoughts to focus or concentrate on activities. They may also find it difficult to make decisions - sometimes to the extent that even small, non-consequential decisions may become paralysing to them.
A person dealing with depression may also experience a change in their psychomotor functioning. They may be agitated - in which case they might constantly require some kind of physical stimulation. They may tap their fingers, wring their hands or pace about. On the other hand, some people may experience a slowing down of their responses. This may affect their emotional responses, speech and actions.
People dealing with depression may also have intense and vivid thoughts about self-mutilation, self-harm or ending their lives. In extreme cases of distress and despair, one may also act upon these thoughts.
The symptoms of depression can vary in terms of presentation and intensity for different people. Men, for instance, tend to notice a drop in energy levels or increase in emotions such as anger and frustration. In contrast, women may experience higher levels of guilt, hopelessness and helplessness; they also are more likely to engage in emotional eating. Younger adults and teenagers with depression may show aggression and withdrawal, whereas older adults may experience loneliness and unexplainable physical aches and pains.
When you read about the signs and symptoms of depression, you may feel empathy for those who experience this illness. You may also wonder what brought them to this situation. Researchers haven’t been able to pinpoint a specific cause for depression, but have identified many factors that increase the risk of experiencing depression.
Often, different factors interact with each other and contribute to the experience of depression.
Genetic history - Depression runs in the family and has a strong genetic basis to it. If you have a family history of depression, it puts you at a greater risk of experiencing depression in the face of stressful situations. However, it is not guaranteed that you will develop depression just because a parent or grandparent has had it. Other factors play a role in depression, too.
Brain chemistry - Studies have shown certain structural anomalies in the brains of people with depression. For instance, the hippocampus - the area of the brain linked to memory and emotion - is significantly smaller in individuals with depression. Depression is also often associated with an imbalance in the levels of neurotransmitters like dopamine, norepinephrine and serotonin, and hormones such as those produced by the thyroid gland.
Chronic pain and disease - There is also a link between chronic illnesses and depression. Some chronic medical conditions, like diabetes, heart disease, lupus, multiple sclerosis and cancer, could trigger a depressive episode. Sometimes the diagnosis of a lifelong illness can also lead to stress and depression. Similarly, chronic pain can contribute to depression since it hampers activity, disrupts sleep, and interferes with the ability to perform tasks.
Major life experiences - Major life events such as shifting cities, losing or starting a new job, marriage, divorce or retirement can cause stress, and even lead to depression. However, depression is more than the expected and normal response to such stressful situations. People can also feel immense sadness and depression because of the loss of a loved one through death or the end of a relationship.
History of abuse - Ongoing physical, sexual, or emotional abuse can put one at a greater risk of depression. Similarly, prolonged neglect, violence, discrimination or poverty can increase vulnerability to depression. If these experiences take place during an individual’s early childhood, it can increase their chances of experiencing depression later in life.
Loneliness and troubled relationships - Social support is one of the strongest protective factors against emotional difficulties. Naturally, then, not having a strong network of people can make it harder for an individual to respond to difficulties in life and can even lead to the experience of depression. This includes not having enough people to reach out to or having poor quality relationships with others.
Personality and coping mechanisms - Certain personality traits can increase the likelihood of feeling depressed. For instance, individuals who are perfectionistic, self-critical, and pessimistic are more likely to experience depression.
Now that you know the different factors that can contribute to depression, it may be easier to understand that there isn’t just one type of depression. Based on the intensity, severity and longevity of the symptoms experienced, depression can be categorised into different types.
Major Depressive Disorder - This is the most common form of depression. It is diagnosed if someone feels depressed most of the time, for most days of the week, for at least two weeks. These symptoms can be managed with regular psychotherapy and antidepressants.
Persistent Depressive Disorder or Dysthymia - If depression lasts for more than two years, it is known as persistent depressive disorder. It is characterised by milder symptoms of a major depressive episode which do not go away for more than two months at a time. Even with this diagnosis, it is possible to experience episodes of major depression - when this happens, it is known as double depression. Persistent depressive disorder is best treated with a combination of antidepressants and therapy.
Situational Depression or Adjustment Disorder - This diagnosis is given to someone who is experiencing depression in response to stressful life events like death, job loss or the end of a relationship. It can even develop if one is facing difficulty in adjusting to seemingly positive events such as marriage or childbirth. Situational depression requires additional support during this period of change, and therapy here is time-limited and solution-focused.
Seasonal Affective Disorder - In this type of depression, a person experiences depressive symptoms only during a certain time of the year. Most often, this happens during winter, when the days are short and sunlight isn’t as strong. The symptoms tend to disappear in spring and summer. With seasonal affective disorder, antidepressants and light therapy can help.
Peripartum (Postpartum) Depression - Since hormones also have an impact on mood, rapid changes in a woman's hormones during pregnancy and after childbirth can also result in a depressive episode. This is known as postpartum depression. Women who experience it once are likely to experience it again during their next pregnancy. Antidepressants and psychotherapy are effective for coping with this type of depression.
Sometimes, depression can occur along with other disorders. This is frequently seen in bipolar disorder, where periods of depression alternate with periods of mania. Here, a person experiences intense mood swings; periods of mania are characterised by elevated mood and energy, while periods of depression are characterised by intense sadness and lethargy. This can be treated with mood stabilisers and therapy. Sometimes people with depression may also experience psychotic symptoms such as delusions. This is known as depressive psychosis and can be treated with a combination of antipsychotic and antidepressant medications. Finally, in atypical depression, a person displays specific patterns of depressive symptoms - such as an increase in appetite and sleep, a feeling of heaviness in arms and legs, oversensitivity to criticism and a temporarily improved mood as a result of a positive event.
To get an accurate understanding of what is affecting a person, it is important to consult with a mental health professional. Remember that depression is a real mental health condition that can be treated with the right kind of support. Scientists have spent decades trying to understand the disorder and have established several lines of treatment that are proven to be effective in helping people feel better. While it may seem like the hardest thing to do, reaching out for help is worth the effort.
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